Emergency medical technician vs. paramedic-placed supraglottic airways for out-of-hospital cardiac arrests.
Resuscitation · 2026-03-09 · Registry study
Abstract
INTRODUCTION: Supraglottic airways (SGA) are common advanced airway devices for out-of-hospital cardiac arrest (OHCA) that are simpler to place than endotracheal tubes. Little is known about SGA placement by emergency medical technicians (EMTs). We sought to evaluate SGA placement by EMTs for OHCA. METHODS: We retrospectively studied the 2019-2023 NEMSIS database. We included adult OHCAs with SGA insertion on first airway attempt. We stratified encounters by the credentials of the provider placing the SGA: EMTs and paramedics. We evaluated the change in SGAs placed by EMTs over time using Cochran-Armitage tests and the number of Emergency Medical Services (EMS) agencies with EMT-placed SGAs over time, and we evaluated regional variation. Using mixed-model logistic regression and compared to paramedics, we evaluated the association between EMT-placed SGAs and first-pass success. RESULTS: SGA placement occurred in 189,307 OHCAs: 41,035 (21.7%) placed by EMTs, 148,272 (78.3%) placed by paramedics. EMT placed SGAs increased from 3140 (20.6%) in 2019 to 10,371 (23.3%) in 2023 (p < 0.01). The number of EMS agencies with EMT-placed SGAs also increased from 664 (38.0%) in 2019 to 1525 (51.7%) in 2023. The regions with the highest proportions of EMT placed SGAs were West North Central (38.9%), East North Central (31.4%), and Mountain (25.0%). First-pass success (SGA) was slightly lower for EMTs (93.7% v 94.3% for paramedics, aOR 0.93 [0.89-0.98]). CONCLUSION: The proportion of SGAs placed by EMTs and the proportion of EMS agencies with EMT-placed SGAs have increased over time. The FPS rate was similar between EMT and paramedic-placed SGAs.